Long Term Consequences
by Oscared
Summary: Only one person knows how to make it stop. From the age of 15, Sam has to deal with chronic pain.


It all starts when he's 14. Just before his 15th birthday. Sam is barely through the door that Friday after school when Dad's barking at them both to pack their bags and get in the car.

It's probably a simple case. Sam's only invited when he's not really needed. He can't really figure that one out. Most of the time the only thing they ask him to do is dig up a grave. He almost always ends up sitting on the trunk of the car, cleaning guns while Dad and Dean strike a match and watch the bones burn.

So he's surprised this time when Dad explains the fairly complicated hunt they're about to embark on. It's a long drive, made even longer by Dean's personal mission of keeping Sam from doing his homework in the backseat.

They crawl through a forest so thick that even if it weren't pitch black out, Sam wouldn't be able to see five feet in front of him. Unfortunately for him, neither can Dean. Sam's so surprised when Dean flies backwards into him that he can't even let out a scream before the air is pushed from his lungs. It's a domino effect: Dean flies into Sam, Sam flies into giant maple, giant maple doesn't move.

The crack is audible. Something's broken. Even before the pain kicks in, Sam knows it's not the tree.

A gun shot rings out from in front of them, Dean scrambles to his feet, Sam...doesn't move.

Dad has the nerve to tell the doctor that Sam and Dean were horsing around in the woods in the middle of the night when they should have been doing their homework. Dean plays along, looks ashamed. Sam's in too much pain to be angry, but stows it away in the back of his mind with all the other infuriating little anecdotes about his father that will one day push him away for good.

Broken scapula. Sam almost throws up when he sees the x-ray. Dean keeps his head down, refuses to look at anything—punishing himself so Dad won't have to, Sam realizes. Dad shakes his head, ruffles Sam's hair and mutters, "Boys, boys, boys. When will you learn, huh?"

Then Sam actually throws up. Just to spite his father.

xxxxx

Sam undergoes surgery the next day, spends a couple more days in the hospital. They release him with heavy painkillers, a prescription for physical therapy, and three dates for follow up appointments.

He doesn't remember his 15th birthday, too high, but is informed that there was cake and that he ate it. He's not so sure he believes that.

It isn't until the immediate, traumatic pain recedes that Sam realizes the long term consequences of the injury.

It first hits him three months later. He wakes in the middle of the night to the sound of his own pain-filled cry. A light is on faster than he can process what's killing him.

"What? What's going on?" Dean's eyes are still squinting out the sudden light, but he's hovering over Sam, panicked, hands splayed.

The pain is like lightning. It's the best way Sam can describe it. Sharps bolts that take his breath away. The spasm grows each time it hits until it reaches its peak, and that's where it stays. For far too long.

"God, my shoulder." He throws his head back into the pillow, can feel his nails puncturing the skin around his left shoulder but can't do anything about it. "Shit, it hurts!" he yells urgently.

Footsteps and another presence. Sam doesn't need to open his eyes to know Dad's now beside him.

A firm grip pries Sam's fingers from the site; they're replaced by a warm hand sliding under his hack and pressing up firmly. "Does that help?"

Sam bucks under the pressure, wants to crawl out of his own skin. The hand is removed, but the damage is done. The static spasm is slowly spreading across his neck, and every time he breathes the pain spikes, so he tries to hold his breath, but it only makes it worse when he's forced to exhale again.

"...on his front," someone says. Sam doesn't have time to prepare himself, and he's crying out as an arm slips between his back and the mattress and gently flips him over.

His breaths keep getting shorter, and eventually he's aware that he's not getting enough oxygen. He chokes, gags, chokes again, and when he can finally suck down a breath, the only reward he gets is an extra surge of pain that radiates from the tip of his skull down through both his spine and left arm. If he didn't know better, he'd think he was being electrocuted.

He's told to do things like relax and breathe and tell them where it hurts. How can they not know? He feels something cold then something hot then something wet then something cold again. None of it lessens the pain, but at least it keeps him slightly occupied, wondering what the hell they're going to try next.

He's dangerously close to full-out sobbing when something absolutely amazing happens. There's a hand poking around his back and neck, then suddenly a few fingers press down in just the right place.

Immediately Sam's whole body stops shaking, the buzzing in his ears disappears, the pain dulls to a livable ache, and he automatically lets out a sigh that screams of relief.

There's a soft chuckle, then, "That help?"

"Yes," Sam breathes out into his pillow. He wants to hug Dean, but that would require moving, and he doesn't dare move an inch. "Don't move," he slurs.

Dean lets out a sigh of his own. "Not going anywhere."

xxxx

Jess knows about his shoulder. He tells her a half-truth in one of her many, fingernail-running-over-scar, "What's this one from?" sessions. She catches him rubbing it sometimes. Even tells him he does it more when he's stressed or tired or sick or nervous. And now that he thinks about it, it tends to bother him more during exams, when he can't sleep, on holidays...

"Really?" he asks.

She smiles, runs a hand down his soapy back and presses her wet, naked body against his from behind.

"You didn't know that?"

He's amazed at the things she knows about him that he doesn't, and always concerned she'll discover something he actually works to keep hidden.

"No, I didn't know that," he answers her honestly.

"You don't have to be nervous about meeting my family, you know. They won't eat you."

He's not nervous—okay he's nervous—but he wasn't stressed about it until she told him her older brother is a cop. Her protective older brother. A cop.

Sam knew he was going to get the once over from Jess' family, but he hadn't anticipated law enforcement. And that - yeah, that made him nervous.

He wears an open collar shirt, buys an expensive bottle of wine, hugs Grandma Moore, offers to help clean up. Sticks to the plan. There's no raid. No riot. Jess' brother even offers to take him to a ball game in the summer.

It starts well before the dinner. The first hints of an ache creep over his shoulder and neck that morning. Almost like an itch. He tries to ignore it, makes a conscious effort not to reach up and hold his shoulder at any time during the dinner, which would surely prompt questions.

_Well, you see, my brother, dad and I, we were hunting this mythical creature in the forest and it threw my brother into me, which sent me into a giant tree. Don't worry, though, my dad shot it dead. The rest is history.__  
_  
See, no normal person needs to hear that.

By the time they say goodbye to Jess' family, Sam's in agony. His stomach is rolling and the buzzing in his ears is growing in volume with each passing minute. Once they're alone in the driveway, Jess keenly offers to drive home. Says he looks pale, asks him if he's feeling okay.

"Just sore," he admits with a grimace, but climbs quickly into the passenger seat before she can pry any further. He doesn't want to talk. He wants to go home. Now.

The drive is torture. Sweat begins to trickle down his back. He has to take shorter breaths to keep the stabbing feeling to a minimum. He can't, however, prevent the gasp that escapes when she stops abruptly at a red light.

She's looking at him. He stares straight ahead, tries not to throw up. "What's wrong? Are you sick?" she asks, reaching up to touch his forehead.

He forces a smile that he hopes looks reassuring. "Nah."

"Your shoulder?"

He nods, allows her to lace her fingers through his. He thinks she has more to say, but the car behind them is honking, and she's forced to pay attention to the road again.

Sam closes his eyes the rest of the trip. He knows the roads well, and internally counts down the seconds remaining until they're home. Once through the front door, Sam manages to mumble something about getting out of the clothes he's wearing, but Jess is in the kitchen, fiddling with the answering machine and doesn't answer.

He's older and stronger now, and he has been through this enough times not to panic, so he is able to summon enough strength to negotiate the stairs to the upper level, even unbuttons his shirt with his right hand and lets it fall off of him and onto the ground before collapsing face first onto the bed.

Jess comes up a few minutes later. He hears her unzipping her dress, chatting casually about the evening. She must notice it's an unusually one-sided conversation because halfway through her rant about her brother's dirty shirt, she stops and asks, "Are you sure you're okay?"

He can't be bothered to lie, not now that he's in his own bed, so in one short breath he says, "No. Not really."

The bed dips beneath her weight, and he has to clench his jaw shut tightly to keep from crying out.

_Don't throw up.__  
_  
"Uh, Sam?" She sounds kind of scared now. "You're_twitching_."

Yeah, he has been told that happens, but it's not like he can see his own back.

"Bottom drawer..." he whispers into the pillow.

She lays a soft, warm hand on his lower back. He can feel her hair tickling the nape of his neck, assumes she's leaning over him. "What was that?"

Sam clears his throat, hates that his voice is shaking in time with his muscles. "In my bottom drawer." He pauses, swallows, composes himself. "Painkillers."

She tries, and he can't fault her for that, but despite his clipped instructions, she doesn't know how to help him. She settles for running her fingernails over his skin, from the nape of his neck to the small of his back, but all it does is help pass the time before the painkillers knock him into a dreamless slumber.

He hears her whisper, "I wish I knew how to love you more," into his ear before he slips under. But that's likely just the drugs.

xxxx

It happens too frequently when Dean's in Hell.

Ruby's hard and cold and, knowing this, Sam keeps her at arm's length. Emotionally, at least. Physically, she's a release. A hot, angry, violent release of the culminating rage and frustration that no amount of alcohol can temper.

She's a tiny ball of power, and though he has to look down at her, he is constantly reminding himself not to underestimate her potential. She demands a level of respect. Not in a "don't speak to me like that" sort of way but more like "I can do worse things than kill you."

When he's not sure he can hate himself any more, she finds a way to facilitate. But she's not useless.

When he feels weak, she gives him the tools to make him feel strong. It's the only thing he needs right now aside from the one thing he needs most. And without her, he'll never get his brother back. Ruby, it seems, is the lesser of two evils.

He doesn't mind the pain. Call it an occupational hazard; call it a distraction. It's part and parcel with this life. He can't escape it so he embraces it. If it doesn't hurt, he tries harder. He pushes to the breaking point – the sick, climactic snap that he craves. Behind him, Ruby's laugh echoes in his ears. "Yes," she encourages, patronizes.

If he's lucky he's unconscious. More often he's in agony, writhing under the poker-hot pain of a migraine and self-hatred.

And he accepts it. Eventually, the pain recedes and the nausea gives way to hunger and just when he's feeling well enough to grieve, he does it all again.

She tells him he's doing too much, that it's going to take time, that he has to be patient. Like her. Strong. Every word out of her mouth perpetuates the self-loathing thoughts that are his fuel. The way she waits for him when he's down, emitting long sighs like he's a burden - dead weight she has to carry. She feeds him pills, lets him down them with mouthfuls of whiskey. She even empties the wastebasket with only the slightest hint of an eye roll that keeps the balance of power just right.

It works for them. Until the first time the crushing migraine is accompanied by an unforgiving series of spasms rocking through his shoulder and back with such paralyzing force that it takes his breath away.

She has to decency to ask what's wrong. He won't unwrap his arms from around his head to answer her, wouldn't even if he could. This is the kind of pain that doesn't help, because if anything, it makes him yearn for his brother even more. And what's the point of all this if it doesn't help him forget?

He's glad she doesn't even try to help - that she leaves him to fight this battle on his own. He imagines Jess' fingernails running up and down his back. And it hurts. God, it hurts. In every possible way. But it's better than the alternative, because the only person that can make this better is out of reach, and if Sam wants to hold on to the few remaining threads of sanity keeping him together, he can't be crying for his brother.

xxxx

"I feel like we're missing something. Maybe we should wait another day. Do a little more research. Make sure we're not overlooking anything."

"Not enough?" Dean asks, obviously confused. Sam knows Dean's looking at him, but refuses to acknowledge what he's sure is one of his brother's best "_What the fuck_?" expressions—instead, he keeps his gaze set straight ahead. "What do you want, an invitation?"

Sam lets out a sigh that fogs up the passenger-side window.

Dean's right. They've pieced together this case perfectly. It should be an in-and-out hunt if they play their cards right. Still, Sam would like just one more day. One more day until they move onto the next one. One more day to let their minds and bodies recover from the last one.

His back and shoulder have been aching since he woke up. It's not unusual in cold, damp weather, but being tossed around like a chew toy by a pack of demons the night before hasn't helped.

He pops some Advil at lunch. Dean glances up from the menu briefly, but doesn't ask what it's for. They're both hurting. Maybe more so than usual. A 15 hour drive of not moving hasn't helped any.

Sam's almost convinced that this time the throbbing isn't going to go any further. He falls asleep in the car after dinner, and when he wakes up again, it's pitch black outside.

"Oh, hello, Princess. Did you enjoy your beauty sleep?"

Sam lifts his head and gasps involuntarily when the pain strikes hard and strong, a white hot explosion that expands all the way up the back of his neck. His first impulse is to stay as still as possible, but a half second later he realizes that he can't hold his leaning pose, and forces himself upright.

"What?"

Dean's voice barely makes it through the filter Sam's brain has set up. He can only process the pain. And yet he can't process the pain. Not this pain.

Instincts are telling him to stretch out, but there's nowhere to go, certainly nowhere to lie flat. He settles for leaning his forehead on the dash, his right hand up on the console to keep him from sliding onto the floor, his left arms held tightly against his chest. He sucks in gulps of Armor All flavored air.

The volume of the music is reduced to soft background noise. He thinks he feels the Impala accelerating.

"Breathe, Sam."

Funny thing: he hadn't realized he wasn't.

If he had known, he certainly wouldn't have stopped breathing to start off with, because when he holds his breath—intentional or not—it makes it a hell of a lot more painful when he does expand his lungs again.

He tries not to swallow the air too quickly, but even so, daggers of pain assault his left side. Spasm after excruciating spasm ricochets through his entire upper body. He feels like a ragdoll at the mercy of his rebelling muscles.

"Hold on. Almost there."

Where? His logical brain wants to ask. They weren't going anywhere specific, so how can they be almost there?

He hates this. Hates that pain-induced tears are running down his cheeks, he hates that after everything Dean has been through over the past few months, he has to watch Sam practically break in two from something so trivial by comparison.

He hates that he can't do anything about it.

There's a slow turn, and then they come to a very gradual stop. Sam doesn't even open his eyes. He doesn't want to see the floor of the Impala, because if he sees it, he might throw up on it.

Then Dean get out of the car, opens the passenger door. Sam's confused when a few seconds later, Dean's on his left side again, a hand firmly on Sam's arm, fingers gently tugging him sideways.

Sam stiffens, grunts, keeps swallowing though he doesn't know why.

"C'mon, Sam. Lie down."

He nods shortly, starts to turn in his seat. Dean's places his other hand on Sam's back which provokes a panicked, strangled, "No, no, don't!"

The hand is removed quickly. "Okay. Okay, relax."

When they're finished, Sam's breathless and wants to scream when he finds he's in more pain stretched out on his back across the Impala's bench then he was cramped upright. Damned if he's going to move again, though.

He has no idea where they are, or where Dean disappears to, and can only imagine what he must look like right now, with his legs sticking straight out the door.

"You're going to have to roll over."

"No."

"Yes. It'll be quick if you let me help you."

Dean doesn't wait for Sam's consent, just slips a hand between Sam's back and the bench seat, grabs a fistful of jacket, and somehow Sam ends up face-down on the seat, gasping into the balled-up sweater that's acting as a pillow.

He feels the practiced fingers walking across his wrecked shoulder, kneading the ball of muscle at the apex then pressing down at just the right angle. And it's the most amazing, cooling relief he has ever felt in his whole life.

Sam groans, savouring the respite.

"Still got it, huh?" Dean grunts. Sam has no idea where Dean is, doesn't want to open his eyes to find out. Judging by all the grunting and rearranging, it's obviously a struggle for him to stay there, but Sam's not about to suggest either one of them make a move.

The sudden expulsion of tension from his body leaves him feeling gummy and drunk. Tears soak the hoodie cradling his face.

"I missed you," he mutters into the thick fabric.

Dean lets out a puff of a laugh. A hand ruffles Sam's hair affectionately.

"Yeah," Dean says. Sam hears him take a deep breath through his nose before he continues more soberly, "Yeah, I know."

"Please don't move," Sam follows up, not caring that he sounds desperate and childish.

"I'm not leaving," Pebbles crunch between asphalt and the soles of Dean's shoes as he readjusts himself, but his hand stays in the magic spot on Sam's back, pressure unwavering. "I'm not going anywhere."

END


End file.
